BY JW Law
A recent article in the New York Times (NYT) reported that roughly 52% of nursing homes that have been deemed high risk continue to receive Medicaid and Medicare funding. Despite the tight scrutiny by the federal and state governments, these nursing homes continue to provide substandard services and operate in treacherous conditions.
For nursing homes to receive Medicare and Medicaid dollars, they are required to comply with regulations set by the Centers for Medicare and Medicaid Services (CMS), a federal agency responsible for administering Medicare and Medicaid programs.
The facilities are randomly inspected by state investigators to determine whether nursing homes are complying with the federal regulations. The inspectors look for deficiencies in the quality of care and in meeting safety requirements. And based on their findings, the nursing homes receive certification from both the state and the CMS.
However, if the inspector finds deficiencies, federal laws require that the problems be corrected. If serious problems are not corrected, CMS has the authority to terminate the nursing home’s participation in Medicare and Medicaid program, which could sound the death knell for this kind of business.
Before that, however, a nursing facility may find its way on the list of what are known as Special Focus Facilities (SFF), an initiative that identifies poorest- performing nursing homes and provides intensified oversight efforts to help them develop practices to overcome their serious issues.
When long-term care facilities are given the status of SFF, it is considered as their final notice to shape up or ship out. For many nursing homes, being labeled an SFF is the last stop before they are closed altogether.
However, an analysis of federal health inspection data revealed that nursing homes that are forced to undergo such inspection often slide back into providing dangerous care. The NYT reported that of the 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.
These nursing homes, spread over 46 states, were included in the SFF list for various reasons including giving wrong medications, failing to protect them from violent or bullying residents and staff members, or neglected to inform families or physicians about injuries. And despite the recurrence of patient harm, these facilities continued to get Medicare and Medicaid reimbursements.
Saul Gruber, Chair of Javerbaum Wurgaft’s Nursing Home Litigation Group, said, “It is essential that there be transparent and significant consequences as a result of continued poor care, this is literally a life and death situation.”
The analysis also found that more than a third of the operating nursing facilities that graduated from the watch list before 2014 still holds the lowest possible Medicare rating for health and safety: one star of five.
While the nursing homes that are on the list for over three years are neither improving enough to graduate off of it nor regressing to be terminated, there are many “one-star” nursing homes, which require attention but are not on the list due to budget cuts. Since 2012 the number of nursing homes under special focus has dropped drastically. In 2017, the $2.6 million budget allows only 88 nursing homes to receive the designation, though regulators identified 435 as warranting scrutiny.
If you are looking for a nursing facility for a loved one, the first place you need to start your research is on the Special Focus Facility list available on CMS website.
You may be tempted to select the nearest nursing home, so that you can visit them often, or pick the one that screams immediate availability or the one that offers an incentive to house your loved one but these may not necessarily be the right fit for them. According to Gruber, when visiting the nursing home bring the information you have collected on the internet and ask the difficult questions face to face.
Christina Ctorides, a nursing home lawyer from JW New York office advises to avoid these special focus facilities altogether, however, if you are considering admission to one of these nursing homes read the following CMS recommendations:
• Visit the nursing home. Talk to staff, residents, and other families. You may request to see the results from the last State or CMS survey (it should be in a place that is easily accessible.)
• Before your visit, look at the survey history of the nursing home on Nursing Home Compare to see what areas may be problematic.
• Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home.
• Call the State survey agency (link to Nursing Home Compare) to find out more about the nursing home. Look at the length of time that a nursing home has been on the SFF list. This is particularly important if the nursing home has been an SFF nursing home for more than 18-24 months since such nursing homes are closer to either graduating (due to improvements) or ending their participation in Medicare and Medicaid.
• Call your local State Ombudsman, Administration on Aging, and local groups to find out more about the nursing home.
• Use the Nursing Home Brochure and Use the “Guide to Choosing a Nursing Home” available on Nursing Home Compare.
[Read Related: A MUST READ FOR ANYONE SELECTING A NURSING HOME]